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PubMed2006

Complications of cough: ACCP evidence-based clinical practice guidelines.

OBJECTIVES: To review the spectrum and frequency of complications associated with coughing. DESIGN/METHODOLOGY: Ovid MEDLINE literature review (through March 2004) for all studies published in the English language, including case series and case reports, since 1966 using the MeSH terms "cough" and "complications." RESULTS: The complications of cough appear to stem from physiologic events. The magnitude of pressures, velocities, and energy that is generated during vigorous coughing allow coughing to be an effective means of clearing the airways of excessive secretions and foreign material, and providing cardiopulmonary resuscitation; however, they can also cause a variety of profound physical and psychosocial complications. The adverse occurrences include cardiovascular, constitutional, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial, respiratory, and skin complications, and a decrease in health-related quality of life. CONCLUSIONS: Knowledge of the spectrum of complications should enable clinicians to appreciate (1) the impact of cough on patients, (2) why it is imperative to exhaust all possible diagnostic and therapeutic options to eliminate cough, and (3) why it is inappropriate to minimize a patient's complaint of cough and/or advise him/her to "live with it."

Cardiovascular Diseases↗
PubMed2006

Cough and the common cold: ACCP evidence-based clinical practice guidelines.

OBJECTIVE: To review the literature on cough and the common cold. METHODS: MEDLINE was searched through May 2004 for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough" and "common cold." Selected case series and prospective descriptive clinical trials were reviewed. Additional references from these studies that were pertinent to the topic were also reviewed. RESULTS: Based on extrapolation from epidemiologic data, the common cold is believed to be the single most common cause of acute cough. The most likely mechanism is the direct irritation of upper airway structures. It is also clear that viral infections of the upper respiratory tract that produce the common cold syndrome frequently produce a rhinosinusitis. In the setting of a cold, the presence of abnormalities seen on sinus roentgenograms or sinus CT scans are frequently due to the viral infection and are not diagnostic of bacterial sinus infection. CONCLUSION: Cough due to the common cold is probably the most common cause of acute cough. In a significant subset of patients with "postinfectious" cough, the etiology is probably an inflammatory response triggered by a viral upper respiratory infection (ie, the common cold). The resultant subacute or chronic cough can be considered to be due to an upper airway cough syndrome, previously referred to as postnasal drip syndrome. This process can be self-perpetuating unless interrupted with active treatment.

Acute Disease↗
PubMed1988

Long-term recording and automatic analysis of cough using filtered acoustic signals and movements on static charge sensitive bed.

Reliable long-term assessment of cough is necessary in many clinical and scientific settings. A new method for long-term recording and automatic analysis of cough is presented. The method is based on simultaneous recording of two independent signals: high-pass filtered cough sounds and cough-induced fast movements of the body. The acoustic signals are recorded with a dynamic microphone in the acoustic focus of a glass fiber paraboloid mirror. Body movements are recorded with a static charge-sensitive bed located under an ordinary plastic foam mattress. The patient can be studied lying or sitting with no transducers or electrodes attached. A microcomputer is used for sampling of signals, detection of cough, statistical analyses, and on-line printing of results. The method was validated in seven adult patients with a total of 809 spontaneous cough events, using clinical observation as a reference. The sensitivity of the method to detect cough was 99.0 percent, and the positive predictivity was 98.1 percent. The system ignored speaking and snoring. The method provides a convenient means of reliable long-term follow-up of cough in clinical work and research.

Acoustics↗
PubMed1988

Cough capacity in patients with muscular dystrophy.

Cough capacity was evaluated in 22 patients with muscular dystrophy (MD) using subjective cough assessment, cough flow-volume curves, maximum expiratory pressures (MEP), forced vital capacity (FVC), and peak expiratory flow rates (PEFR). In ten of the 22 patients transients of peak flow were generated during cough flow-volume maneuvers, indicating dynamic compression of the airways, which is considered important in the physiology of an efficient cough. Patients who could not generate peak flow transients had significantly reduced PEFR, FVC, and MEP values. Measurement of MEP was the most sensitive predictor of flow transient production during coughing; all of the patients who exhibited transients had MEP values of above 60 cmH2O, whereas the highest value of MEP recorded in patients without transients was 45 cmH2O. Three of the 12 patients who were unable to generate flow transients were considered to have an adequate cough by subjective assessment. We concluded that the measurement of MEP is extremely useful for assessment of cough strength in patients with MD.

Adolescent↗
PubMed1990

Hyperresponsiveness of the extrathoracic airway in patients with captopril-induced cough.

It has been suggested that cough from captopril may originate from an increased sensitivity of receptors in the extrathoracic airway (EA). To explore this hypothesis, we assessed the responsiveness of EA and bronchi and the cough sensitivity to inhaled histamine in nine hypertensive patients with captopril-induced cough (group 1) during treatment and one month after withdrawal of the drug treatment. Nine patients who were asymptomatic while receiving captopril (group 2) and nine patients receiving no current treatment (group 3) served as controls. The EA responsiveness was assessed by using the maximal midinspiratory flow (MIF50) as an arbitrary index of EA constriction and was expressed as the histamine concentration causing a 25 percent decrease in MIF50 (PC25MIF50). PC15FEV1 was the index of bronchial responsiveness and PCcough (dose causing five or more coughs) was that of cough sensitivity. Airway hyperresponsiveness (EA-HR or BHR) was diagnosed when PC25MIF50 or PC15FEV1 were 8 mg/ml or lower. Patients with captopril-cough, as compared with controls, had significantly lower values of PC25MIF50, PC15FEV1, and PCcough; EA-HR and BHR were found, respectively, in seven and three of these patients and in none of the control subjects. In all the patients of group 1, cough and EA-HR resolved after withdrawal of captopril treatment, while BHR persisted in one. PC25MIF50, PC15FEV1, and PCcough were all significantly improved. Our findings suggest that cough during captopril therapy may originate from receptors in the EA.

Bronchial Provocation Tests↗
PubMed2005

Drugs to suppress cough.

Cough is an important defensive reflex of the airway and also a common symptom of respiratory disease. Cough after common respiratory virus infection is transient but is more persistent when associated with conditions such as asthma, rhinosinusitis, gastro-oesophageal reflux, chronic obstructive pulmonary disease and lung cancer. Persistent cough may be due to peripheral and/or central sensitisation of cough reflexes initiated by cough receptors, rapidly adapting receptors or nociceptors. Treatment directed at associated conditions such as asthma (with anti-inflammatories) and gastro-oesophageal reflux (with proton-pump inhibitors) improve cough. There remains a need to use drugs that suppress the neural activity of cough (termed nonspecific), as treatments directed at the clinical cause(s) of the underlying cough (termed specific) may not be effective. The most effective indirect antitussives are opioids such as morphine, codeine or pholcodeine, but they produce side effects such as drowsiness, nausea, constipation and physical dependence. Opioids such as kappa- and delta-receptor agonists, non-opioids such as nociceptin, neurokinin and bradykinin receptor antagonists, cannabinoids, vanilloid receptor-1 antagonists, blockers of Na+-dependent channels, and large conductance Ca2+-dependent K+-channel activators of afferent nerves may represent novel antitussives.

Antitussive Agents↗
PubMed1996

ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms and management.

A dry, tickly and often bothersome cough is the most common adverse effect of ACE inhibitors. Recent studies indicate that cough may develop in around 10% of the patients treated with ACE inhibitors. In half of these patients, the ACE inhibitor has to be discontinued. Cough has emerged as a class effect occurring with all ACE inhibitors with no clear difference between the single substances. While ACE inhibition is safe in the vast majority of patients with obstructive airways disease, asthmatic symptoms or exacerbation of asthma as well as a rise in bronchial reactivity have been occasionally reported. ACE inhibition increases the cough reflex. The mechanisms underlying ACE inhibitor-induced cough are probably linked to suppression of kininase II activity, which may be followed by an accumulation of kinins, substance P and prostaglandins. Physicians should be aware that a dry cough is the most common adverse effect of ACE inhibitors and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later. Replacement by another ACE inhibitor should not be tried, since the cough will almost always recur on rechallenge with the same or another ACE inhibitor. After withdrawal of the ACE inhibitor, which is the treatment of choice, cough will resolve usually within a few days.

Airway Obstruction↗
PubMed1987

Smoking and cough syncope: follow-up in 45 cases.

A follow-up review of 45 patients with cough syncope was performed to ascertain the effect of therapy in relieving symptoms. These patients constituted 2.5% of all Mayo Clinic patients evaluated over a 3-year period for syncope. Cough syncope patients were predominantly male (43:2), the average weight was 96.1 kg, and the average age was 53.2 years. Eighty-two percent were current or ex-smokers at the time of the initial evaluation and 86% of those having pulmonary function tests demonstrated findings consistent with obstructive lung disease. Treatment was determined by their primary physician and, in general, was aimed at decreasing the cough. Cough-related symptoms were abolished or improved in 97% of patients. Smoking cessation was closely associated with decreased symptoms. Although felt by both patient and physician to be a benign disorder, cough syncope can result in severe bodily injury. Patients with a vigorous cough, especially smokers, should be questioned thoroughly about cough syncope. Treatment of cough is effective in relieving symptoms.

Adult↗
PubMed1991

[Dry cough in the elderly patients treated with angiotensin converting enzyme inhibitor].

Since dry cough has recently been recognized as a side effect of angiotensin converting enzyme (ACE) inhibitors employed in the treatment of hypertension or congestive heart failure, the incidence of dry cough in elderly patients receiving ACE inhibitors was investigated. There were 237 out-patients on either captopril, enalapril, or delapril, in August and November 1989. Questionnaires concerning dry cough and smoking were completed by 184 patients. Patients either less than 50 years of age, or with chronic pulmonary disease were excluded. The remaining 168 patients, 63 males, 105 females, with a mean age of 73 years were analyzed for the incidence of a dry cough in relation to age, sex, smoking, and type of drugs. The overall incidence of a dry cough was 21/168 (12.5%), 7/63 (11.1%) for males and 14/105 (13.3%) for females, and was less frequent with advancing age; in the 51-60 age group 4/11 (36.4%), in the 61-70 age group 5/39 (12.8%), in the 71-80 age group 9/75 (12.0%), in the 81-90 age group 3/40 (7.5%), in the 91- age group 0/3 (0%). Enalapril showed significantly higher incidence of dry cough than captopril (16/93, 17.2% vs 7/88, 8.0%, p less than 0.05). Delapril showed an incidence 4/11, 36.4%, however, 9 out of the 11 patients who were given delapril had had a history of a dry cough with captopril or enalapril, and in 4 out of these 9 patients the dry cough disappeared by replacement of captopril or enalapril by delapril.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Respiratory muscle strength and cough capacity in patients with Duchenne muscular dystrophy.

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n= 32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 +/- 586 mL) was higher than that of VCs (1474 +/- 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 +/- 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 +/- 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 +/- 49 L/ min) and volume assisted PCF (VPCF; 252 +/- 45 L/min) (F = 66.13, p < 0.001). MIP (34 +/- 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 +/- 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.

Adolescent↗
PubMed1995

Chronic cough associated with subacute bacterial endocarditis.

Although the literature on subacute bacterial endocarditis from both the preantibiotic and antibiotic eras mentions cough as a symptom, neither bacteremia nor endocarditis is listed in reviews on chronic cough. Herein we describe a 74-year-old man who underwent an extensive workup as an outpatient because of chronic cough of 7 months' duration. Chest roentgenography, chest and sinus computed tomography, fiberoptic bronchoscopy, gallium scan, transthoracic echocardiography, and other studies revealed no apparent cause for his nonproductive cough. Because of a persistently increased erythrocyte sedimentation rate and associated weight loss, blood cultures were obtained, all of which grew Streptococcus constellatus. A transesophageal echocardiogram revealed mitral valve vegetation. After antibiotic therapy was administered, the patient's cough completely resolved. He has experienced no coughing for more than 14 months. Bacteremia in conjunction with endocarditis should be added to the list of uncommon causes of chronic cough. The mechanism of cough is unknown.

Aged↗
PubMed2006

Cough in children: definitions and clinical evaluation.

The aetiology and management approach for cough in children differs greatly to that in adults, so the empirical approach commonly used in adults is unsuitable for children. Clinical evaluation of cough in children should include an assessment of environmental factors, particularly tobacco smoke, parental concerns and expectations. Most children with acute cough are likely to have an uncomplicated viral acute respiratory tract infection, but the possibility of a more serious problem, especially aspiration of foreign material, should always be considered. Isolated chronic cough in children is rarely asthma, and the term "cough variant asthma" should not be used. Over-the-counter and prescription medications are ineffective for the symptomatic relief of acute cough. Treatment for chronic cough should be based on aetiology. Because of the favourable natural history of cough, a "positive" response in medication trials should not be assumed to be due to the medication. Children should be reassessed within the expected timeframe of response to therapy.

Acute Disease↗
PubMed2001

The applied physiology of cough.

The cough reflex is such an important defense mechanism of the respiratory tract that a thorough knowledge of its applied physiology in respiratory disease is essential for clinicians. It is a well-integrated reflex, which has afferent limb consisting of receptors and afferent nerves, the central cough center in the brainstem and the efferent limb consisting of motor nerves supplying the muscles of coughing. The cough process consists of inspiratory phase, compressive phase and expiratory phase. Stimuli that can initiate the cough process can be central or peripheral in the lungs or outside the lungs. The important function of the cough reflex is to maintain the airways and alveoli clear and healthy. The mechanisms by which it achieves this are (i) high velocity of expiratory gas flows produced in the expiratory phase (ii) the compression of the lungs and airways by high positive pleural pressure generated in the compressive phase. Cough threshold can be determined by giving acetic acid, citric acid or capsaicin inhalation challenge test. This has practical application in clinical research. The pathophysiological basis of different types of cough encountered in clinical practice is discussed.

Acetic Acid↗
PubMed2001

[Management of chronic cough in high volume medical offices: efficacy of a sequential protocol].

INTRODUCTION: Chronic cough is one of the main causes of medical consultation. There is not however an homogeneous attitude regarding its management. A prospective evaluation was performed of a simple therapeutic protocol based on the anatomical approach of the cough reflex. METHODS: A total of 110 patients with chronic cough for longer than four weeks were studied. The exclusion criteria were: non-smoking during the last year, not to have diseases compromising the immune system and not to have received inhibitors of the angiotensing converting enzyme. A three-visit stepwise approach was performed with specific diagnostic tests ordered and a specific therapy instituted according to the clinical suspicion. RESULTS: At the third visit, 97% of patients were free from cough or had improved markedly. Cough causes were identified in 105 cases (95%) and the most common were: asthma (33%), postnasal dripping (29%), gastroesophageal reflux (10%), and asthma with associated gastroesophageal reflux (16%). Patients with asthma had a longer duration of tos compared with those who had postnasal dripping (p < 0.05) as the only differential feature. CONCLUSIONS: The diagnostic-therapeutic diagram based on the anatomic reflex of cough is useful for the management of chronic cough in a highly demanded medical office. With this protocol, the cause of cough can be identified and treated successfully in almost every patient with a small number of diagnostic tests and medical visits.

Adult↗
PubMed2002

[Comparison of reproducibility to measure cough sensitivity between our original and astograph methods].

BACKGROUND: We have established a 15-seconds tidal breathing method using our originally developed apparatus to measure cough sensitivity to capsaicin. Astograph, an apparatus to measure bronchial responsiveness to methacholine, has been widely used in clinical practice in Japan. If Astograph is available for measurement of cough sensitivity, it will contribute to promoting the spread of cough sensitivity test. METHODS: Fifteen-seconds tidal breathing methods using our original apparatus and Astograph were compared in 29 healthy subjects. To assess the agreement of the two methods, increasing concentrations of capsaicin solution were inhaled for 15 seconds until 5 or more cough were elicited and cough threshold, the lowest concentration of capsaicin eliciting 5 or more coughs, was determined by each method on 2 separate days at one week interval. On each day, the cough threshold measurement was repeated twice at one-hour interval to assess the repeatability. RESULTS: Difference and repeatability coefficient were 0.35 and 2.00 in our original method and 0.14 and 1.88 doubling concentration in Astograph method, respectively, indicating good repeatability of both methods. Difference and coefficient of agreement between the two methods was 0.30 and 2.44 doubling concentration, respectively. CONCLUSIONS: Astograph is suitable for measurement of cough sensitivity to capsaicin because of its good repeatability and agreement with our original method already established.

Adult↗
PubMed2002

Chronic cough. Three most common causes.

OBJECTIVE: To describe an approach to diagnosis and treatment of patients with chronic cough. QUALIITY OF EVIDENCE: MEDLINE was search for reports of studies comducted between 1970 and 2000 on chronic cough and its epidemiology, natural history, diagnois, and theraphy. Articles were further selected based on clinical relevance and design. Most articles reviewed were epidemiology cohort and case studies and reviews. MAIN MESSAGE: Chronic cough, a commom ailment amoung adults, is often a diagnostic challenge. Most cases of chronic cough are associated with postnasal drip syndrome (PNDS), asthma, gastroesphageal reflux disease (GERD), or some combination of these. Initial investigation should include chest radiography to ruke out more ominous causes of chronic cough. Examinations and trials of treatment can diagnose PNDS, asthma, and GERD. Combination treatments are often necessary for managing chronic cough. CONCLUSION: The most common causes of chronic cough are PNDS, asthma, GERD, or some combination of these. A systematic approach to diagnosis and treatment is effective for most cases of chronic. cough.

Asthma↗
PubMed2002

Fentanyl-induced coughing and airway hyperresponsiveness.

BACKGROUND: The tussive effect of fentanyl, in sharp contrast to the antitussive effect that common opioids have, is not rarely seen in clinical anesthesia. Pretreatment with beta 2 agonist inhalation could dramatically suppress fentanyl-induced coughing. We hypothesized that airway hyperresponsiveness might exist in large proportion of the subjects who had experienced fentanyl-induced coughing during previous anesthesia. METHODS: We designed a case-controlled matching study to investigate the correlation between fentanyl-induced coughing and airway hyperresponsiveness. Twenty-six consecutive subjects (ASA I-III), who experienced fentanyl-induced coughing during anesthesia in our hospital from 1999 to 2000, were enrolled in this study as the fentanyl-cough group. In all the subjects baseline spirometry was first obtained. Airway responsiveness was evaluated with either PC20 of methacholine challenge test or bronchodilator test. After matching age and sex, another 26 subjects without history of fentanyl-induced coughing during previous anesthesia were also enrolled in the study as the control group. RESULTS: The proportion of airway hyperresponsiveness in fentanyl-cough group and control group was 30.77% and 19.23% respectively. After pairing of these two groups, McNemar test revealed no significant difference in the proportion of airway hyperresponsiveness between these two groups (P = 0.257). CONCLUSIONS: From the analysis of the present study, we cannot prove that there is a direct correlation between fentanyl-induced coughing and airway hyperresponsiveness.

Adolescent↗
PubMed2003

[Postmarketing surveillance of benazepril-related cough and related risk factors analysis on hypertensives].

OBJECTIVE: To investigate the risk factors of benazepril related cough. METHODS: Case-control study nested in a community-based postmarketing surveillance was carried out. One thousand eight hundred and thirty-one hypertensive patients screened from a Chinese community were recruited to take benazepril for 3 years. Demographic characteristics and behavior risks were investigated and the level of uric acid and creatinine were tested at baseline. Episodes of benazepril related cough during follow period were recorded. RESULTS: Within half a year of administration, the incidence rates of cough were as high as 18.35% in women and 12.11% in men. Incidence decreased significantly when time went by. Two years later of administration, first occurrences of cough were still seen. Based on logistic regression analysis, women were more likely to develop cough (OR = 2.193, 95% CI: 1.500 - 3.206). The association between decompensated kidney function and cough occurrence was only detected in women (OR = 3.432, 95% CI: 1.954 - 6.028). Women aged 65 or more had 1.672 (95% CI: 1.040 - 2.688) times risk than women aged 35 to 64 years. In men, the OR of developing cough was 1.689 (95% CI: 0.976 - 2.924) for daily drinking alcohol less than 100 g but increased to 2.478 (95% CI: 1.148 - 5.347) when drinking 100 g or more, but not the determinant ones. CONCLUSION: Women, older age, drinking alcohol and decompensated kidney function were the possible risk factors for benazepril related cough, but not the determinant ones.

Adult↗